Dr. Brad Hylan’s Dentistry Blog

I am 56 years old and up until last week had all four wisdom teeth. Last week I had the two top wisdom teeth removed due to a broken filling. No problems with complications or dry socket, now a week later. My question is, should I seriously consider having the other two wisdom teeth removed, though I have never had any problems with them? My dentist advised having an oral surgeon do the removal if I elect to have them removed. Your thoughts…

Thank you in advance.
- Russell from Texas

Dear Russell,
There should be a reason for removing wisdom teeth, besides just that they’re wisdom teeth.

It sounds like your wisdom teeth were all normally erupted, and not impacted. Impacted wisdom teeth should be removed as early as possible – like by age 25 is best, because the potential for later complications with them is a significant risk.

There can, however, be problems with wisdom teeth that have erupted normally. They can be difficult to restore, so if they need extensive work, it may be advisable to have them out. They can complicate your home care by making your second molars more difficult to keep clean. In your case, if the upper wisdom teeth have been removed, the lower wisdom teeth could tend to super-erupt and end up hitting the gums of your upper jaw. If any of these are problems in your mouth, then it may be justified to have them extracted now.

All of these issues are matters that have to be sorted out by looking at your mouth. Its a judgement call, and I would just refer you to the opinion of your own dentist on that.

I had a lower back molar extracted and now there is bone poking through the gum. Why does that happen and what options do I have for taking care of it?
- Mike from Virginia

Mike,
There is nothing wrong if there is bone poking through your gum after your tooth extraction, unless it’s causing some pain.

What happens after a tooth is extracted is that the bone that is left may have sharp edges because of the hole in the bone that is created. As your gum shrinks around that bone, the sharp edges can be left exposed. In time, your body remodels this bone and smooths everything over.

If it is too irritating to you, you can have your dentist smooth out the bone. That’s an easy procedure that doesn’t require novocain because there are no nerve endings in that bone. If it’s accessible to you, you could smooth it off yourself with a nail file.

Other links:
Read about Dr. Hylan’s Cleveland emergency dentist policy.

I had a root canal on the upper 1st & 2nd molars 2 years ago; both crowns recently broke off at the gum line. My oral surgeon extracted both teeth but did not raise a flap. When I touch the hole left behind there is still a hard piece left embedded. It is not hurting but I want to get an implant. Does this piece have to be removed?

thanks,
Vrajesh from India

Vrajesh,
I’m not sure I understand what you mean by a hard piece left behind, and I don’t know how much bone is left for supporting a dental implant. But maybe I can help by explaining a little about the healing process after an extraction.

A tooth extraction will leave a hole, and there will often be sharp edges of bone because the tooth is gone. Over a period of weeks and even months, your body will re-shape that bone to be smooth, and will fill in the socket of the missing teeth with new bone. During that time, there can still be an open hole which will probably collect food debris and have a bad taste to it.

A dental implant is an excellent option for replacing a missing tooth. With no tooth in the space, your body will gradually resorb the bone that used to hold the tooth in place. An implant prevents this bone loss.

My son is getting 2 teeth pulled tomorrow. He has been on antibiotics for 3 days, but there is still some swelling in his jaw. Is it safe to have them removed?
- Jessica from West Virginia

Jessica,
I can’t comment on your son’s particular case without seeing it, but I can give you some general guidelines. And the main principle you need to know is that you can never get rid of an infection from an infected tooth without treating the tooth—either a root canal treatment or extracting the tooth. Antibiotics can’t get to the inside of a tooth.

Sometimes, because of the position of a tooth, an infection will get in the way of getting a tooth numb, and in those cases we’ll want to get the infection under control before extracting the tooth. Other times, when there is a surgical extraction, we’ll also want to get the infection under control because there is a chance that the surgery could spread the infection. Many times, no antibiotic at all is needed. But even when an antibiotic is used, the goal is to get the infection under control to where it isn’t spreading any more and we know that the antibiotic is working. We don’t need the infection gone—in fact, it isn’t possible to get the infection eliminated until the tooth is treated.

I hope this is helpful.